Public Policy is social agreement written down as a universal guide for social action. We at The Policy ThinkShop share information so others can think and act in the best possible understanding of "The Public Interest."

Being “in the shadows” has long been a healthcare access issue. The broken healthcare system has been aggravated by a broken immigration system. Immigration and healthcare are tied together in many ways, especially for the economically disadvantaged.

According to the New York Times:

What Is President Obama’s Immigration Plan?

President Obama announced on Thursday evening a series of executive actions to grant up to five million unauthorized immigrants protection from deportation. The president is also planning actions to direct law enforcement priorities toward criminals, allow high-skilled workers to move or change jobs more easily, and streamline visa and court procedures, among others. NOV. 20, 2014 RELATED ARTICLE

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Who could be affected?

The president’s plan is expected to affect up to five million of the nation’s unauthorized immigrant population, currently 11.4 million according to the Migration Policy Institute. It would create a new program of deferrals for approximately 3.7 undocumented parents of American citizens or legal permanent residents who have been in the country for at least five years. Deferrals would include authorization to work and would be granted for three years at a time.

It would also expand a program created by the administration in 2012 called Deferred Action for Childhood Arrivals, or DACA, which allows young people who were brought into the country as children to apply for deportation deferrals and work permits. The plan would extend eligibility to people who entered the United States as children before January 2010 (the cutoff is currently June 15, 2007). It would also increase the deferral period to three years from two years and eliminate the requirement that applicants be under 31 years old. About 1.2 million young immigrants are currently eligible, and the new plan would expand eligibility to approximately 300,000 more.

Healthy food is not easy to prepare, does not have a very long shelf life, and is more expensive than cheaper canned and mass produced “food” that contains fillers and other ingredients that return adequate profits, facilitate transportation, refrigeration, and distribution.

America’s food consumption and health connection problem goes well beyond socioeconomic issues of lack of cash and proximity and access to healthy food. Our society’s economy produces commodities and commodities are distributed based on market forces of supply and demand. Supply and demand pressures have thus far overpowered the traditional forces on the side of promoting community health. The loosing forces are:

Social do-gooders

Philanthropy

Public health officials

Conscientious parents

Suburban focused and lead prevention efforts

In short, economic forces have thus far trumped social ideas and groups aiming to undo what are basically the macro and micro consequences of food production and distribution.

Any successful efforts in this area will have to have for-profit corporations at the table with philanthropy and government officials providing public policy leadership and incentives that appeal to corporate America’s economic interests and social responsibility (good corporate citizen) commitments.

Are you familiar with the RWJ report titled “The Future of Nursing: Leading Change, Advancing Health” by the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Penn Medicine (University of Pennsylvania Health System)?

As we know, initiatives like the one that produced this report, as recent as 2011, come and go. What remains is the report and what committed professional like yourself and our colleagues do with the information.

We at The Policy ThinkShop were inspired by a nurse colleague not only to pullout this report but to post a comment on our blog for your benefit.

“In 2008, The Robert Wood Johnson Foundation (RWJF) approached the Institute of Medicine (IOM) to propose a partnership to assess and respond to the need to transform the nursing profession. Recognizing that the nursing profession faces several challenges in fulfilling the promise of a reformed health care system and meeting the nation’s health needs, RWJF and the IOM established a 2-year Initiative on the Future of Nursing. The cornerstone of the initiative is this committee, which was tasked with producing a report containing recommendations for an action-oriented blueprint for the future of nursing, including changes in public and institutional policies at the national, state, and local levels (Box S-1). Following the report’s release, the IOM and RWJF will host a national conference on November 30 and December 1, 2010, to begin a dialogue on how the report’s recommendations can be translated into action. The report will also serve as the basis for an extensive implementation phase to be facilitated by RWJF.”

The report explains the committee of experts charge in producing the study and report as follows:

The committee may examine and produce recommendations related to the following issues, with the goal of identifying vital roles for nurses in designing and implementing a more effective and efficient health care system:

Reconceptualizing the role of nurses within the context of the entire workforce, the shortage, societal issues, and current and future technology;

Expanding nursing faculty, increasing the capacity of nursing schools, and redesigning nursing education to assure that it can produce an adequate number of well prepared nurses able to meet current and future health care demands;

Examining innovative solutions related to care delivery and health professional education by focusing on nursing and the delivery of nursing services; and

Attracting and retaining well prepared nurses in multiple care settings, including acute, ambulatory, primary care, long term care, community and public health.

“In 2008, the Robert Wood Johnson Foundation approached the Institute of Medicine (IOM) to propose a partnership between the two organizations. The resulting collaboration became the two-year Robert Wood Johnson Foundation Initiative on the Future of Nursing at the IOM. The committee was chaired by former U.S. Secretary of Health and Human Services Donna Shalala, and the goal was to look at the possibility of transforming the nursing profession to meet the challenges of a changing health care landscape. The report produced by the committee, The Future of Nursing: Leading Change, Advancing Health, makes specific and directed recommendations in the areas of nurse training, education, professional …”

No other substance on the planet is so embedded in our happiness and in our suffering like alcohol is. As Americans, we are moving away from some forms of alcohol but are embracing wine with new vigor. The World Health Organization (WHO) recently released an comprehensive report that enumerates alcohol consumption issues and social problems. You can follow the following link provided by The Policy ThinkShop to read the full report.

“Worldwide, 3.3 million deaths in 2012 were due to harmful use of alcohol, says a new report launched by WHO today. Alcohol consumption cannot only lead to dependence but also increases people’s risk of developing more than 200 diseases including liver cirrhosis and some cancers. In addition, harmful drinking can lead to violence and injuries.

The report also finds that harmful use of alcohol makes people more susceptible to infectious diseases such as tuberculosis and pneumonia.

The “Global status report on alcohol and health 2014″ provides country profiles for alcohol consumption in the 194 WHO Member States, the impact on public health and policy responses.

“More needs to be done to protect populations from the negative health consequences of alcohol consumption,” says Dr Oleg Chestnov, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health. “The report clearly shows that there is no room for complacency when it comes to reducing the harmful use of alcohol.”

Some countries are already strengthening measures to protect people. These include increasing taxes on alcohol, limiting the availability of alcohol by raising the age limit, and regulating the marketing of alcoholic beverages.”

Report highlights

The report also highlights the need for action by countries including:

national leadership to develop policies to reduce harmful use of alcohol (66 WHO Member States had written national alcohol policies in 2012);

national awareness-raising activities (nearly 140 countries reported at least one such activity in the past three years);

health services to deliver prevention and treatment services, in particular increasing prevention, treatment and care for patients and their families, and supporting initiatives for screening and brief interventions.

The Polity ThinkShop brings you this important report on the State of our American State

Have unions been dealt yet another blow, now ironically by the well intentioned ACA reform?

If the federal government mandates that business and individuals obtain insurance is this setting a president for the federal government to regulate and mandate worker gains without the use of union muscle?

These are provocative questions, at least for people who still remember the sacrifices that were made to create unions and the horrible conditions that preceded them.

“Last week’s vote by workers at Volkswagen’s Chattanooga, Tenn. plant against joining the United Auto Workers union — despite VW’s tacit encouragement — points up the challenges faced by U.S. organized labor. Even though unions retain much public support, the share of American workers who actually belong to one has been falling for decades and is at its lowest level since the Great Depression.

In a Pew Research Center survey conducted in June 2013, about half (51%) of Americans said they had favorable opinions of labor unions, versus 42% who said they had unfavorable opinions about them. That was the highest favorability rating since 2007, though still below the 63% who said they were favorably disposed toward unions in 2001. In a separate 2012 survey, 64% of Americans agreed that unions were necessary to protect working people (though 57% also agreed that unions had “too much power”).”

The Kaiser Family Foundation has released its first survey of the population finding new health coverage under the recently implemented ACA reform. The survey delineates two main groups taking advantage of the increased access to health insurance: those who had non-group coverage and those who had no insurance at all. The experiences of these two groups may prove important, the report goes on to say, with significant implications on how the success of the ACA reform is judged.

Apparently, the success of the ACA reform in brining people into the insured fold may be limited by financial literacy, insurance literacy, and health literacy deficits evident in the Kaiser Family Foundation survey.

A preliminary read of the survey report findings by The Policy ThinkShop points to an emergent need to address health literacy in the newly covered group in order to ensure that coverage recipients understand how to take advantage of their presumed efficacy in the insurance market and in their presumed increased access to healthcare itself and cost saving prevention health services. According to the survey:

“Health insurance is complicated, and many previous studies have documented gaps in health insurance literacy among consumers. The survey finds evidence of this among those who purchase their own coverage, with many respondents unable to answer some basic questions about their plans. For example, nearly one in five non-group enrollees (18 percent) say they don’t know the amount of their monthly premium and almost four in ten (37 percent) don’t know the amount of their annual deductible. Among those with ACA-compliant plans, three in ten (30 percent) say they don’t know the metal level of their plan (platinum, gold, silver or bronze), and among those who report getting a government subsidy to defray their premium cost, nearly half (47 percent) couldn’t say what the amount of the subsidy is.”

The survey report goes on to highlight the segment of the population surveyed who are more privileged because of their prior experience obtaining insurance:

“Some groups are more knowledgeable than others, including college graduates, those with higher incomes, and small business owners. Plan switchers, who likely have more experience buying coverage in the non-group market, are also more likely than those who were previously uninsured to be able to report the metal level of their plan and their premium and deductible amounts.”

“January 1, 2014 marked the beginning of several provisions of the Affordable Care Act ACA making significant changes to the non-group insurance market, including new rules for insurers regarding who they must cover and what they can charge, along with the opening of new Health Insurance Marketplaces also known as “Exchanges” and the availability of premium and cost-sharing subsidies for individuals with low to moderate incomes. Data from the Department of Health and Human Services and others provide some insight into how many people purchased insurance using the new Marketplaces and the types of plans they picked, but much remains unknown about changes to the non-group market as a whole. The Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees is the first in a series of surveys taking a closer look at the entire non-group market. This first survey was conducted from early April to early May 2014, after the close of the first ACA open enrollment period. It reports the views and experience of all non-group enrollees, including those with coverage obtained both inside and outside the Exchanges, and those who were uninsured prior to the ACA as well as those who had a previous source of coverage non-group or otherwise.”

When you visit your doctor does (s)he look happy? At the end of the day healthcare is a one on one personal experience. All the insurance coverage or fancy machines in the world won’t improve medical care if the doctor patient relationship is not optimal.

So what is our healthcare system doing to address physician happiness? The Gallup organization took a closer look at hospitals, one place where physician practice is defined and sustained–for better or for worse…

“When doctors are frustrated, patient care and hospital revenues suffer. Heres how hospitals can engage their physicians — and make a positive impact on patients and the bottom line.”

An aging America may not necessarily be a quiet and content America. People born in the post war boom, challenged religion, government and authority in all their forms. As an aging generation, they want the healthcare system to take care of them.

Baby boomers have grown up in what can be termed the age of technology and optimism, with mankind at the center of the universe and economic progress an ever churning engine. Much of the healthcare conversation in America is not about doctors and patients but about costs and insurance. Americans spend a great deal of money on healthcare. All the recent talk about healthcare seems to be impacting expectations on the role of doctors and healthcare outcomes. Americans expect doctors to save lives.

One of the challenges of healthcare in America is getting people to understand it, to connect their behavioral choices with healthcare outcomes and to value wellness over consumption. Feeling good does not always lead to feeling well. America can be an indulgent society and today’s youth want it all and they want it now. Americans do not value their healthcare until it is a problem they can feel or until they understand what is happening to them as something that can threaten their mortality. Americans want to live for ever and their attitudes regarding the role that a physician should play regarding preserving life is moving in that direction.

“At a time of national debate over health care costs and insurance, a Pew Research Center survey on end-of-life decisions finds most Americans say there are some circumstances in which doctors and nurses should allow a patient to die. At the same time, however, a growing minority says that medical professionals should do everything possible to save a patient’s …”

“Fall 2013 will begin to usher in the key health insurance coverage expansions of the Affordable Care Act (ACA), with open enrollment in new health insurance Marketplaces beginning on October 1, 2013, and Medicaid expanding to adults in states moving forward with the ACA Medicaid expansion as of January 1, 2014. During summer 2013, with open enrollment rapidly approaching, many states were in high gear to finalize preparations for outreach and enrollment efforts to help translate these new coverage options into increased coverage for millions of currently uninsured individuals. This report provides insight into preparations in Maryland, Nevada, and Oregon -three states that have established a State-based Marketplace, are moving forward with the Medicaid expansion, and are among the states leading the way in preparing for outreach and enrollment. The findings provide an overview of where these three states are in establishing their Marketplaces; preparing for the Medicaid expansion; planning for marketing, outreach and enrollment; and establishing enrollment assistance resources. They also highlight the challenges that states have encountered and overcome, the successes they have achieved, and the key lessons that may help inform implementation efforts moving forward.”via Getting into Gear for 2014: Insights from Three States Leading the Way in Preparing for Outreach and Enrollment in the Affordable Care Act | The Henry J. Kaiser Family Foundation.

Information is to behavior as technology is to understanding. Let me clarify. Technology is increasingly making it more “mobile” and convenient to obtain, process and include health related information in our daily activities and decision making. In fact, physicians and patients are likely to increasingly benefit from recent advances in more mobile and popular forms of social media tools–such as Apps–in their need to manage health related information as providers of care and consumers, respectively. Take for example Apps and search engines. These two increasingly popular and used tools for accessing and managing health information are increasingly impacting a physician’s ability to learn and deicide and a patient’s ability to “get a second opinion” or increase their health literacy as they are more able to ask question and get immediate answers from numerous sources without having to rely on the often limited patient doctor relationship. The Pew foundation does a nice job of keeping us up to date on how the internet is changing every aspect of our lives–including healthcare.

“Susannah Fox will deliver a keynote address to a symposium hosted by the Albert Einstein College of Medicine at Yeshiva University. She will discuss the Pew Research Center’s latest findings related to technology adoption and use in both the U.S. and abroad, with a particular focus on the social impact of the internet on health and health care.”

You are a leader… Whether it is for your family, your organization or your company, you need to have a handle on healthcare reform.

The following is a quick guide you can use and share with others in your efforts to stay “intelligent” on the often confusing and misinformed healthcare debate vs. what the law now being implemented really is…

The Kaiser Foundation has some of the most current and accurate information available on this important subject.

Here is a quick guide to what you need to know about them:

1.

The insurance marketplaces are open to nearly everyone, but If you have insurance through work, Medicare or Medicaid, it’s likely you won’t need to shop for coverage there. They are really for people who are uninsured or folks who buy individual policies now.

2.

Many people will qualify for subsidies to make coverage more affordable there. These subsidies – tax credits to help pay your premiums – will be available to people with incomes up to 400 percent of the federal poverty level. That\’s about $46,000 for one person or $94,000 for a family of four. And there are cost-sharing subsidies to reduce deductibles and copayments, depending on your income.

3.

Immigrants who are in this country illegally are barred from buying on the exchanges.

4.

You can enroll until March 31, 2014, though you\’ll generally need to sign up by Dec. 15 of this year, to be covered as of Jan. 1. You can find your state’s marketplace at healthcare.gov.

5.

Through the marketplace, you can compare health plans in your area. The prices are based on where you live, your family size, the type of plan you select, your age and whether you smoke. All the plans have to comply with the Affordable Care Act’s requirement to have a basic benefits package, but the amount you have to pay in premiums, co-pays and deductibles will vary among plans.

6.

When you apply for coverage on the exchange, you will find out if you’re eligible for subsidies to help pay for premiums. Or, if you have a low income, you can also learn if you are eligible for Medicaid coverage.

7.

Your income — not your assets, such as your house, stocks or retirement accounts – will count toward determining whether you can get tax credits. When you buy your plan, you estimate your income for next year, and your tax credit is based on that estimate. The next year, your tax returns will be checked by the IRS and compared against your estimate.

8.

If you qualify for a tax credit to pay your premiums, you can choose to either have the credit sent directly to the insurer or pay the whole premium up front and claim the credit on your taxes. If you qualify for cost-sharing subsidies, that subsidy will be sent directly to the insurer, and you won’t have to pay as much out of pocket.

9.

If your income increases during the year, notify the exchange promptly so that you can avoid having to pay back the credits. On the other hand, if your income goes down, you could be eligible for a bigger subsidy. Either way it\’s important to notify the exchange if your income changes.

10.

Each plan covers 10 “essential health benefits,” which include prescription drugs, emergency and hospital care, doctor visits, maternity and mental health services, rehabilitation and lab services, among others. In addition, recommended preventive services, such as mammograms, must be covered without any out-of-pocket costs to you.

11.

You won’t have to pay more for insurance if you have a medical condition and that condition will be covered when your policy begins. But older people can be charged more than younger people and smokers could face a surcharge.

12.

The prices for the marketplace plans are likely to be similar to those sold privately. If your broker offers you a plan that is also available on the exchange, you may be eligible for subsidies.

13.

Your insurer generally can\’t drop you, as long as you keep up with your insurance premiums and don\’t lie on your application. Generally, people will be able to enroll in or change plans once a year during the annual open enrollment period. This first year, open enrollment on the exchanges will run for six months, from Oct. 1 through March of next year. But in subsequent years the time period will be shorter, running from October 15 to December 7.

14.

There are certain circumstances when you would be able to change plans or add or drop someone from coverage outside the regular annual enrollment period. This could happen if you lose your job, for example, or get married, divorced or have a child.

15.

The number of plans that you can choose from is likely to vary widely. In some states, only a couple of insurers have announced plans to offer policies though the marketplace, while in others there may be a dozen or more. Even within a state, there will be differences in the number of plans available in different areas. You can expect that insurers will offer a variety of types of plans, including familiar models like PPOs and HMOs.

Given today’s liberalization of news information, few bastions remain where one can sift through the cacophony of media bites and babble to form an educated

opinion or assess an educated risk. The Economist is failing in this regard on the American debate on healthcare reform–The Affordable Care Act.

Healthcare reform in America is a struggle for power and wealth at the increasingly small American top and a life and death struggle for most of the people below.

If we loose respected journals like the Economist in these times of mass information as intellectual fodder for the masses, we will be left without an intellectual meeting place where concerned minds can gather to contemplate benchmarks and directions. Regarding The Affordable Care Act debate in America, not only has the current president failed to sell and communicate the important of ACA implementation, he has once again betrayed the needs of the many for the expedient and self serving calculus of preserving power and status by appealing to an imaginary center–not too different here from the pragmatic Bill Clinton on Welfare Reform. But we digress.

The Economist has been a reliable source for decades as it has proven to be an \”objective\” source of information on the complex world stage. It\’s recent coverage of the American scene, however, requires vision and focus if it is going to support the journal\’s reputation as one of the few sources that our college professors respected that were not refereed journals.

The headline of the above story, \”The Obamacare sofware mess,\” is as semantically charged as it is irrelevant to any of the public policy issues raised by a serious American healthcare market debate addressing the important issue of how healthcare is distributed, facilitated or accessed by people in need of healthcare services.

Semantics: The term \”Obamacare\” plays directly into the divisive and charged narrative that portrays the healthcare debate in America as a tug of war between an \”evil and un-American\” president and American freedom. The framing of the current full court press, by conservatives, to obstruct the American president, at all at all costs, and the popular will of a democracy, is akin to saying that Churchill failed to stop Hitler sooner or to foresee the costs of settling with Stalin because of his neonatally determined speech impediment. It is academically irresponsible and intellectually dishonest, at least on the pages of this fine journal, to stain this usually intellectually rigorous space with narratives that are more appropriate in pop news sources that entertain people who are looking to reinforce their own deeply held biases and/or myopic political world views.

The Economics has been a leading world source of factual information relevant to the business of serious policy discourse and sober business leadership.

The foregoing comments are submitted on behalf of the Policy ThinkShop blogging team.

As a not for profit, non partisan source of policy analysis and conversation, we rely heavily on sources like the Economist to promote reason and thoughtful

conversation on all things public policy….

Please reconsider your use of the American public policy discourse and reflect on your use of language to add to and further support our current cacophony of obstructionism and self promoting pragmatism in the pursuit of popular power and further public policy noise…

In seemingly endless times of “trash talk” that led to an improbable and unpopular political victory, the newly minted president clamors: “Now arrives the hour of action.” Fleeting relief comes to the nation as the transition […]

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